Yet another air medical crash.

[paramedicmike]

This one in Oklahoma.

Rest easy, brothers.

Here's a link to the article.

[k_emt13]

It kinda shook me. That is a very close team. My hearts and prayers go out to their families and their EMS family members.

[Just Plain Ruff]

truly truly sad, prayers for our colleagues

The question is this, what was the patient's condition that prompted the flight?

I find more and more that inappropriate flights occur daily. Chopper shopping goes on all the time.

Can't get this one to fly, maybe another one will.

Got a fracture and a hospital without orthopedic staff, fly em out rather than take them by ground.

Got a membership to that service? Go ahead and call em, the membership will cover you.

The question I have for all the members on this board. Does your service use helicopters approrpriately?

Does the helicopter service that covers your area offer monthly Review sessions of flights and provide feedback as to what is appropriate and what is not an appropriate flight?

If not then I suggest that you start. Most helicopter services provide that service for free.

Don't just say that your service's QI/QA program can police itself, that's what my former employer said and according to one of the flight team that covers our area told me, "a large number of flights that they run from our service are inappropriate and could have been taken by ground" That says volumes to me. Without feedback from the helicopter service, those services who use helicopters willy nilly will continue to put those flight crews in unneeded danger.

[uglyEMT]

truly truly sad, prayers for our colleagues

The question is this, what was the patient's condition that prompted the flight?

I find more and more that inappropriate flights occur daily. Chopper shopping goes on all the time.

Can't get this one to fly, maybe another one will.

Got a fracture and a hospital without orthopedic staff, fly em out rather than take them by ground.

Got a membership to that service? Go ahead and call em, the membership will cover you.

The question I have for all the members on this board. Does your service use helicopters approrpriately?

Does the helicopter service that covers your area offer monthly Review sessions of flights and provide feedback as to what is appropriate and what is not an appropriate flight?

If not then I suggest that you start. Most helicopter services provide that service for free.

Don't just say that your service's QI/QA program can police itself, that's what my former employer said and according to one of the flight team that covers our area told me, "a large number of flights that they run from our service are inappropriate and could have been taken by ground" That says volumes to me. Without feedback from the helicopter service, those services who use helicopters willy nilly will continue to put those flight crews in unneeded danger.

Rest Easy Brothers

Ruff answering your question.. my squad does use the birds very appropriatly. Ours are run by State Police and not a private but we do get feedback from them all the time. We call the bird when we know darn well the 1 hr ground to the Level 1 Trauma or the 2hr to the Burn Center will expire the patient. Most of our traumas will go by ground with ALS aboard and we do so fairly regularly. Haven't had a burn in a while so I dont have any recent knowlege for that one.

As an example last weekend we had a multi patient MVA and one went by brid the other was ground. The bird was extended extrication (35 minutes of cutting around this poor kid), alot of internal injuries. Ground was broken leg and pelvis but without the extended extrication (FD just needed to cut the door off and we boarded under 5 minutes). One of our rookies did ask why both were not flown and it was explained that the leg and pelvis while painful was not an immediate life threat and ALS felt ground was a viable option while the extended extrication with internal injuries were an immediate life threat and most of our golden hour was wasted extracating so air was necessary.

[Just Plain Ruff]

But those aren't the calls in question from my post.

The calls in question are the ones like no orthopedic services at local hospital so let's fly them. Heck, I know of one flight that was for a fractured ankle. Circulation was compromised by the dislocation but the local ER doc could have at least tried to reduce the dislocation/fracture. (this is not my previous employer)

Calls for flights when originally the doctor said they could go by ground but the nurse in the ER said "They have the membership so why don't we fly them." I saw this numerous times at my previous employer.

Those above are blatant examples of flights that were inappropriate and put the flight crews in danger for convenience of the EMS and ER staff rather than patient needs.

And I've also witnessed (and at one time have been a part of) chopper shopping.

There used to be a service that would fly in almost any inclement weather. This was back in the 90's and they even came down during a light snowstorm to get a pediatric patient post code. When they got to our hospital the snow increased and they were not able to continue the transport so precious time was wasted waiting for a helicopter when the ground ambulance (me and my partner) could have had the kid there sooner.

[uglyEMT]

I see Ruff. I misread the post. The question was rehtorical I guess.

I do see your point now of uncalled for air flights. Those scenarios you mentioned were definatly uncalled for. I cant imagine the flight company allowing the pilots to actually take the calls.

Chopper shopping sounds crazy too. Having companies that will pull gun-ho stunts just to say they fly.

[tniuqs]

No disrespect intended for the fallen brothers:

Please Don't Call Them Heroes

Please don't call them "heroes" or "fallen angels" or any of that other pap. Last Thursday, pilot Allan Dale Harrison and flight nurse Ryan Duke were killed in the crash of an air ambulance in Kingfisher, Oklahoma. Their flight paramedic was injured.

Shortly after dropping off a patient at a hospital about 7:30 July 22, the helicopter went down into a rural area and caught fire. Unlike the majority of helicopter crashes, the flight was being operated in daylight and in clear weather. It's too early to know what caused the accident. But please, please, please, air crash investigator, when considering the factors that contributed to this latest air ambulance accident, take a broader look at whether this industry is it's own disaster.

In the December 2009 issue of Emergency Physicians Monthly (What, you don't subscribe?) three doctors put it bluntly. What if, several times a year there was medical procedure that -- when it went wrong -- killed the medical team along with the patient? There would be an outcry, the doctors say. Things would be scrutinized, things would change. Yessir! BUT, here is their point, "Although such a scenario may seem outrageous, it is essentially the same risk that helicopter EMS crews face on a daily basis," and it is the only medical procedure that is more likely to kill the medical provider than the patient.

Ok, so Drs. Bledsoe, Abernathy and Carrison surely got the attention of the emergency room physicians with that opening paragraph. I wish I'd written it. But how to get the attention of everyone else, everyone who continues to believe that air ambulances are a benevolent public service, offering valuable time-saving transport for the critically injured and that the cost of saving these lives means that a few paramedics or pilots will die every now and then. I want to take another stab at altering this perception because I think it is dangerous. I think the facts are persuasive enough to get the public past the dramatic made-for-TV-movie version of the story.

Helicopter medical transport is a multi-billion dollar industry.

It makes its profits by putting people into helicopters.

It maximizes profits by cutting costs.

Putting patients into helicopters begins with convincing the public that faster is better. For years we've been hearing about the "Golden Hour" that critical time between injury and medical treatment that is the difference between life and death. A number of published emergency physicians think its a myth. (Read more about this here and here.) Nevertheless, we are convinced that speed equals better outcome. Thus we expect that everything from car crashes to broken bones, are worthy of a trip to the hospital by air. The next thing you know, every fire department, rescue unit and hospital is partnering with an air ambulance provider to bring in the casualties.

Like a well-powered rotor the air ambulance industry spins into an ever bigger enterprise, requiring ever more riders. In 2009, nearly half a million people in the United States were moved by air ambulance. Since 2002 the number of helicopter ambulances has quadrupled. Score a big one for the companies -- an addiction to helicopter transport has been achieved.

But business success depends not only on generating revenue -- costs must be controlled too. Oh yeah, it's a challenge to operate helicopters and employ highly trained aviation and medical professionals while keeping a tight hand on the checkbook. On the other hand, air ambulance operators are in a unique situation. The rates they charge aren't linked to the quality of the equipment they use or the personnel they hire.

Say what? That's right, a company using an old single engine aircraft with a low-time pilot and fresh-out-of-school medical crew gets paid the same as a company with a brand new, twin-engine, two pilot, highly experienced nursing team on board. (And since you were probably wondering, that's about $8,000 -- $16,000 per flight. More on who gets to pay the tab in a future blog.)

So not unexpectedly, the vast majority of helicopter operators in the United States are flying single-engine, single-pilot helicopters. Safety equipment like terrain awareness, auto-pilot, or night vision goggles are left to each operator's discretion -- who's feelin' generous?

So please don't call the casualties "heroes" or "fallen angels." Call them evidence that the public has been bamboozled into believing we need to be flying around by air even when the injury is not life threatening, just-in-case. And call them victims of an industry that's off-the-radar, fueled with cash and powerfully incentivized to keep on doing it just this way.

[Just Plain Ruff]

Squint, you validated my point exactly right.

You were more eloquent and better spoken though.